public health services facing the twin challenge of climate change and petroleum peak
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Public health servicesfacing the twin challenge
of climate changeand petroleum peak
G S Leonardi
Medical Epidemiologist, Fellow of the Faculty of Public Health
Chilton Seminar, 30th November 2012
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What does the future hold?
Increases are of sluggish growth, but the
way to ruin is rapid.
Lucius Anneaus Seneca
If a man takes no thought about what is
distant, he will find sorrow near at hand.Confucius, Analects 15, 11
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Outline
Global climate and environmental change
Examples of impacts, including epidemiology
Petroleum peak
Changes to public health services
Increase focus on water
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Public Health Action
Empedocles (490-440BC), accordingto Diodorus, managed to makeSelinunta a healthy town throughirrigation.
The area suffered from malaria andcontaminated water.
By opening up two rivers to the sea,he channelled slack water anddrained the swamps making thewater drinkable.
Sanitary works minimised the
epidemic of fever in Selinunta.This is one of the earliest PublicHealth Projects
Changes in malaria can be mitigatedby public health action
http://upload.wikimedia.org/wikipedia/commons/7/79/Empedokles.jpeg -
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Acknowledgements
Tony McMichael Andy Haines
Paolo Vineis
Sari Kovats
And many others
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Health is influenced by
lifecourse factors (early infections and other experiences)socio-economic position
psychology
educationnutrition
health care systems
environment (physical, chemical, ecological, mediated byhousing, workplace, transport)
(see articles on Health, Wealth, and Ways of life,
Social Science & Medicine Volume 74, Issue 5, March 2012Available at: http://bit.ly/zKr6AT)
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Public health service definition and functions
Definition
Environmental public health: the science and art of
prevent ing disease, pro long ing l i fe and promot ing
health where env ironmental hazards are the key factor ,
through organised efforts of society
Functions
Environmental health services implement this by risk
assessment, management and communication, in
relation to accidents, water quality, air quality, food
quality and safety, waste management and soil
pollution, human ecology and settlements
(WHO 2001)
(Spiby 2006)
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200 2,000 20,000
Societal economic growth: GNP/person over time
(in notional US dollars)
Air pollutants:particulates, O3, Nox
Lead Occupational hazards
Water quality Urban noise
Atmospheric carbon dioxide Persistent Organic Pollutants Ozone-depleting gases Urban nonbiodegradable waste
Exposureor
environmentaldamage
Household sanitation Aflatoxin in food Black smoke
(Wilkinson, 2006)
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(Rockstrom et al, Nature 2009)
Exponential rise of everything
(Rockstrm et al, Nature 2010)
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The Nature and Value of Ecosystem Services:An Overview Highlighting Hydrologic Services
(Brauman 2007)
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Climate Changeoccurring faster
than expected
1m: half of Bangladesh rice fields2m: most of Mekong Delta
IPCCs Fourth Assessment Repo rt(2007) now looksconservative[in addition to cautious review process]
Subsequent research shows increasing rates of:
Global Greenhouse Gas emissions
Ice melting (Arctic sea ice, Greenland/Antarctic ice-sheets, alpine glaciers)
Sea level rise
Also:
Increasing saturation of carbon sinks (land and oceans)
Estimated amount of carbon stored in permafrost
= twice the atmospheric carbon
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Overall losses and insured lossesabsolute values and long-term trends of majorweather-related catastrophes 1950-2009
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Health Risks:Looking to wider horizons
Acid rain
(regional)
Global climatechange
Direct, toxic, hazard
Disruption oflife/health-support
systems
Environmentaltobacco smoke
Local air pollution
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Climate Change and theGlobal Burden of Disease
WHO World Health Report2002estimated that, in 2000,global climate change was already responsible, indeveloping countries, for:
2.4% of diarrhoeal disease
Up to 6-7% of malaria and dengue in specified groups of high-risk countries
Substantial declines in regional food yields (and, therefore,levels of malnutrition)
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(Patz 2005)
WHO estimated mortality (per million people)attributable to climate change by the year 2000
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Climate Change: Health Impact PathwaysPhysicalsystems
(river flows, soilmoisture, ocean temp)
Biologicalcycles, innature &
Ecologicallinks/function
Economic/socialimpacts:infrastructure,farm/factory production, GDPgrowth, jobs, displacement
Human Health:
Injuries/deaths Thermal stress
Indirecthealthimpactsecologicallymediated
Indirecthealthimpacts
sociallymediated
Direct impacts(extreme weatherevents, heatwaves,air pollutants, etc.)
Infectious diseases Under-nutrition Mental stresses
Other disorders
ClimateChangeImpacts
(McMichael 2009)
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Past FuturePresent
Learn Detect
Forecasting,
modelling
Three Main Types of Research
Empirical studies
Adaptation (incl evaluation)(McMichael 2009)
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Research Category I
Learning about climate variation
and health risks from pastevidence
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Heat waves, warmer
winters, injuries,floods
Mosqui to-borne
diseases, food
pois oning, al lergies
secondary
pr imary
tert iary
Health impacts of climate change
Food scarcity, famine, conflict,
displacement, refugees,
development failure
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2003 = 4th hottest summer
Brogdale (Kent) recorded England'shighest temp 38.5 C on 10 Aug
> 32 C was exceeded 4 - 6 August and 8 -12 August,
June 1976, temperatures exceeded 32 C (90F), somewhere in the UK, on 15 consecutive
days starting 23 June.
Temperature distributionacross Europe on 10
August 2003 at 1500hrsBritish Summer Time
Heatwave: MaximumTemperature, August 10, 2003
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Daily temperatures and deaths in major Parisianhospitals, July -August 2003
50
100
150
200
250
2 4 6 8 10 12 14 16 1825 27 29 31July August
Max daily temp
Min daily
temp20
25
30
35
40
15
Deaths TempoC
Stott et al (Nature, 2004): The
underlying warming trend over recentdecades in Europe (predominantlyhuman-induced) had doubled theprobability of such an extreme
heatwave occurring.
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Drinking Water Salinity and Maternal Health
in Coastal Bangladesh: Implications of
Climate Change
MonthNo. of cases
Total no. of
pregnancies
Prevalence rates of
hypertension (with or
without proteinuria)
(95% CI)
MaySept 20 393 5.09 (2.917.26)
OctApril 70 576 12.2 (9.4814.8)
Total 90 969 9.28 (7.4611.1)
(Khan 2011)
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Flood events in 1994-2005
24
Total:
319 events (8,886 boundaries)
1,095km2 (1,680km2in gloss)
Exposed population (estimate):
67k households
237k persons
Target p/cs : 2,159,132
Flooded 4,814 (0.2%)
N-flooded (
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Climate Change and Infectious Disease
Many infectious diseases are climate-sensitiveespecially vector-borne diseases
Some recent changes in ID patterns mayreflect influence
of climate change:Tick-borne encephalitis (Sweden)
Cholera in Bangladesh
Malaria in east African highlands
Time-trends in food-borne (infectious) disease
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Source: Climate Change Futures, 2005
Malaria
cases
Malaria and Floods in Mozambique
Maputo
precipitation
Malaria cases
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Relative Change in Malaria Incidence Before, During and AfterEl Nio EventsVenezuela, 20th-century annual time series
2.0
-2
1.8
1.6
1.4
1.2
1.0
0.8
Mean Proportional Change
-1 0 (Nio) +1 +2
Time Lag (years)
Coast (1910-1935)
Whole country
Average of both
Bouma & Dye. JAMA 1997
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Fitted values of monthly Salmonel lacounts in relationto monthly temperature in five Australian cities, 1991-2001
0
10
20
30
40
50
60
70
80
90
100
9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
Temperature oC
Salmonellacou
nt
Perth
Brisbane
Adelaide
Melbourne
Sydney
DSouza et al., 2003
2 oC rise 12% increase
5 oC rise 25% increase
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Research Category II
Seeking evidence of currenthealth impacts of climate
change
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Hot weather and calls to NHS Direct
0
10
20
30
40
0 10 20 30Temperature (average of lags 0-1)
Total symptomatic calls
0.00
0.20
0.40
0.60
0.80
1.00
1.20
1.40
1-Jul-03
8-Jul-03
15
-Jul-03
22
-Jul-03
29
-Jul-03
5-Aug-03
12
-Aug-03
19
-Aug-03
26
-Aug-03
ProportionofNHSDirectheat/sunstrokecalls(%)
Proportion of heat/sun stroke calls Severe heat periods
(Leonardi, 2006)
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NHS Direct calls in summer 2006
4 peaks:
11th June, 3rd July, 19th July, and 26th July
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Greenland Ice Sheet:Increase in Area Melted in Summer, from
1992 to 2002. (Arctic Climate Impact Assessment, 2004)
Orange area = melt-zone
1992 2002
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H i K t i N O l
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Hurricane Katrina, New Orleans,USA, 2005
Natural or Unnatural?
Hurricane Katrina Passing over Gulf of Mexico (NASA 2005)
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Hurricane Katrina Passing over Gulf of Mexico (NASA, 2005)
Yellow, orange, and red areas at or above 82F (27.8C, thetemperature required for hurricanes to strengthen).
Increasing power of tropical cyclones over
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Change incyclonic
power (PDI),and Temp oC
0.8 oC rise1975-2004
1930 2010
Increasing power of tropical cyclones overpast 30 years in Nth Atlanticrelationship
to sea-surface temperature
Emanuel K.Nature 2005; 436: 686-8
Year
Power Dissipation Index, PDI
= f (wind speed3)
September sea-surfacetemperature, SST
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Christopher Field, Carnegie Institute for
Science, in testimony to US Congress,
1 August 2012
It is critical to understand that the link between climate
change and the kinds of extremes that lead to disaster
is clear,.There is no doubt that climate has changed, he went
on. There is also no doubt that a changing climate
changes the risks of extremes, including extremes that
can lead to disaster.He later told the committee that those climate-related
disasters would have profound effects on industry and
agriculture.
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Research Category III
Estimating future CC scenario-based health impacts
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Daily maximum temperature:probability of exceedance
Central England
temperature
Baseline (1961-90)
2080s, medium-high
emissions
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Change innumber of"extremely"warm days indifferentemission
scenarios
UK Climate Impact
Programme
1990
http://www.ukcip.org.uk/scenarios/definitions/definitions.htmlhttp://www.ukcip.org.uk/scenarios/definitions/definitions.htmlhttp://www.ukcip.org.uk/scenarios/definitions/definitions.htmlhttp://www.ukcip.org.uk/scenarios/definitions/definitions.html -
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1990
2085
Estimated regionalprobability of
dengue occurrence
under medium
climate change
scenario: 2085 vs
1990Using statistical
equation derived
from observations of
recent distribution of
disease in relation to
meterological
variables
Source: Hales et al.
Lancet, 2002.http://image.thelancet.
com/extras/01art1117
5web.pdf
Probability
http://image.thelancet.com/extras/01art11175web.pdfhttp://image.thelancet.com/extras/01art11175web.pdfhttp://image.thelancet.com/extras/01art11175web.pdfhttp://image.thelancet.com/extras/01art11175web.pdfhttp://image.thelancet.com/extras/01art11175web.pdfhttp://image.thelancet.com/extras/01art11175web.pdf -
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(Boxall et al EHP 2008)
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Food insecurity
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Fischer et al, 2001 (IIASA)
2080: rain-fed cereal production
ECHAM4 model of the Max Planck Institute of Meteorology
Phenology
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Phenology
Changing species range: beech
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Changing species range: beech
baseline 2050s Low 2050s High 2080s High
(Broadmeadow 2008)
Changing distribution of ash
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Changing distribution of ash
1961-90 2020s
2050s 2080s
ECI/BRANCH project: www.branchproject.org.
Climate space
retained
Climate space
gained
Climate space
lost
Current
distribution
ESC it bilit f NVC dl d
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ESC suitability for NVC woodland
1961-90 2050s High2050s Low
Lowland ash
Upland ash
Lowland oak
Upland oak
Yew
Beech woodland
Acid oak
Upland oak/birch
Unsuitable
Wet woodland
Alder woodland
European variations in the temporal trend of bird
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European variations in the temporal trend of birdand butterfly community temperature index
(EEA 2012)
Observed latitudinal shifts of four species groups
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Observed latitudinal shifts of four species groupsover 25 years in Britain
(Chen, 2011)
Projected spatial mismatches of the Portuguese
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j p gDappled White butterfly and its host plants
(EEA 2012)
Ph t hth ff ti t d f
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Phytophthora ramorum affecting a stand ofJapanese larch (Larix kaempferi) in Plym Woods,east of Plymouth
(Sturrock
2011)
Range expansion of soybean cyst nematode
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g p y y
(Heterodera glycines) from 1971 to 1998
(Niblack, 1999)
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David
Waltner-Toews and
Tim Lang,
2001
The severe drought in the Midwest is affecting
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The severe drought in the Midwest is affecting
prices for corn and soybeans as well as other
field crops which should, in turn, drive up
retail food prices. However, the transmissionof commodity price changes into retail prices
typically takes several months to occur, and
most of the impact of the drought is expected
to be realized in 2013.
From website of USDepartment of Agriculture
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(Health Impacts of Catastrophic Climate Change, 2011)
Stationarity is dead
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Stationarity is dead.
Times have changed, and the change isongoing. The full extent and nature of the
change are uncertain. The impacts are
even foggier. In view of this, what are the
appropriate adaptations to address thoseimpacts?
Addressing this question will be a major
challenge for water science during the
21st century.(Milly 2007)
The growing gap between oil discovery and
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g g g yproduction
(Hanlon 2008)
Progressively higher production costs ($/b) related to globalit (Mb/d)
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capacity (Mb/d)
(The Oil Crunch. A wake-up call for the UK economy, Industry
Taskforce on Peak Oil & Energy Security, February 2010)
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Peak oil
the point where "the cost of
incremental supply exceeds the
price economies can pay withoutdestroying growth at a given
point in time.
Chris Skrebowksi, petroleum economist
Rising energy costs a challenge for
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Rising energy costs a challenge fordevelopment (social, cultural and economic)
(Orlov 2011)
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(Moss 2010)
Population transitions, past and current
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(UN 2004)(Gignoux 2011)
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Public health services baseline trend
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Public health services baseline trend
Local health departments are a critical yet increasingfragile component of governmental infrastructure
Budgetary shortfalls
Shifting public health workforce demographics
New set of emergency response expectations
departments have been forced to do
more with fewer resources
advice and monitoring, not directlyresponsible for actions/interventions
(Barnett 2011)
Climate impacts add to the health burden now
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Climate impacts add to the health burden nowand more in future
Temperature
An increase in mean temperature of 2.0C (0.2 C) in winter and about 4.0 C (0.3 C) in summerby the end of the century.
The longest cold spell per year (days below 0 C) will decrease, with the greatest reduction of about7 days (1 day) over Scotland.
Hot spells (defined as periods with daily maximum temperature higher than 25 C) are projected to
be prolonged on average by up to 10 days (+1 to 2 days) over Central and Southern England, andby less than 5 days over the rest of the UK.
Rainfall
Total summer rainfall has decreased by about 50 mm over the last 250 years
Autumn and winter rainfall have both increased by about 50 mm.
Wind
Episodes of very high wind speeds are expected to decline in the UK.
Increases predicted over Wales, Northeast England, and Northwest Scotland.
Public health role in managing crises, eg
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Public health role in managing crises, egflooding, cold weather emergencies
Ni l f h
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Nine meals from anarchy
(Lord Cameron of Dillington, 2008)
Petroleum scarcity and public health:
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Petroleum scarcity and public health:considerations for local health departments
-Further tightening of budgets
-Dependence on transportation
-Dependence on petroleum-based medical supplies
Most affected essential services might be:
-Monitoring
-Diagnosis and investigation
-Access to vulnerable communities
(Barnett , AJPH 2011)
Public health will be affected in numerous ways
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ub c ea be a ec ed u e ous aysin a phase when energy is limited. Redefinitionof public health role may be a part of redefinition
of roles for many other agents in society.
A few possible strategies:
Surveillance: ensure electronic data collection, use of
home-based office for conducting inspection visits
Diagnosis and investigation: develop and test
nonpetroleum substitutes for medical and lab supplies
Microlocalization: including neighbourhood pods
Consider need for geographic access to care when
developing interventions
(Barnett , AJPH 2011)
Climate
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(Leonardi, Chapter 12.How to Prepare for theHealth Effects ofClimate Change)
Climate
change:
challengesto public
health,
and possibleresponses
Th i bl di (NCD) ff t f
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The noncommunicable disease (NCD) effects ofclimate change mitigation and adaptation strategies
(Friel 2011)
noncommunicable disease (NCD) effects (continued)
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(Friel 2011)
Resilience
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(i) Disaster resilience describes the capability of a community
or society to resist and recover from a disaster.
(ii) Community resilience describes the capability (or process)of a community adapting and functioning in the face of disturbance.
(iii) Ecosystem socialecological resilience describes
the capacity of natural and social systems to absorb disturbancewhile remaining within the same functional state.
(iv) Infrastructure resilience describes the capacity of builtinfrastructure to continue functioning during disasters. This might
include roads, buildings and bridges.
(v) Individual or psychological resilience describes thecapacity of individuals or groups of people to cope with adversity
and continue functioning.
(Castleden 2011)
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(export),th i l k f
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their lack ofwater for food production with trade (import), and
to meet their remaining deficits
(Rockstrm 2010)
Blue water and green water
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(Rockstrm 2010)
Redistribution of Water Resources
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Redistribution of Water ResourcesChanging risk of unmet water demands
Changing risk of floods
Changing risk of droughts
Legal and operational roles and responsibilities of
public agencies in relation to water management willneed to be clarified and specified accordingly
(Milly, 2005)
Model-Projected Changes in Annual Runoff, 2041-2060
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j g ,Percentage change relative to 1900-1970 baseline. Any color indicates that >66%of models agree on sign of change; diagonal hatching indicates >90% agreement.
(After Milly, P.C.D., K.A. Dunne, A.V. Vecchia, Global pattern of trends in streamflow andwater availability in a changing climate, Nature, 438, 347-350, 2005.)
Climate Change and Water:
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Climate Change and Water:
The Big Questions
The past: What has been happening?The future: Where are we headed? What areas areat risk?Mitigation: How much change is avoidable?Adaptation: What will the unavoidable changeslook like?
(Milly 2005)
Scientific Information
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Scientific Information
for Adaptive Adaptation
Identification and quantification ofvulnerabi l i t ies
Hydrologic and climatic moni tor ing
Comprehensive environmental model ingInterpretive research
Enhanced communicat ionwith resource managers
(Milly 2005)
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Haines 2006
An essential public health service is maintaining
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p gand managing supplies of water for essentialuses: drinking and crop growing
Priority is for public health services to have a clear
picture of the crucial role of provision of water fordrinking and crop growing
If distribution of water and food is ensured, the
remaining human activities, however limited and
changed by circumstances, are possible
Public health service cannot act on behalf of
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Public health service cannot act on behalf ofeverybody else only advise
BUT in a crisis, provision, management, andallocation of water has been and likely will be ofmajor importance to public health
Water will be a priority. Available energy
resources should be directed to it
All hands to the pumps!
Conclusions:
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Climate and other environmental change, and rising
energy costs pose new challenges to public healthservices
A multi-disciplinary (health, forestry, agriculture,
engineering, meteorology, geology) recognition is
needed of:
-Influences on water by ecological parameters and human activities
- water availability affects healthOn that basis, a framework is needed for developing
public health services that will ensure appropriate
advice/action is taken to provide water for essential
health needs
Outline
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Outline
Global climate and environmental change
Examples of impacts, including epidemiology
Petroleum peak
Changes to public health services
Increase focus on water
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